[Paradox arterial embolism: diagnosis during life]. / Embolia arterial paradójica: diagnóstico en vida.

Paradoxical systemic embolism in the absence of congenital heart disease is often considered a clinical or pathologic rarity. We have recently observed two cases of paradoxical systemic emboli, secondary to massive pulmonary embolization in the presence of a patient foramen ovale in an otherwise normal heart. One case was lethal and the diagnosis was confirmed at autopsy. The other case was diagnosed by cardiac catheterization with dye dilution curves and the patient recovered after recurrences were prevented by the placement of an inferior vena cava umbrella-filter. Paradoxical embolization should be suspected when systemic emboli occur without an apparent cause. The diagnosis can be established by cardiac catheterization, pulmonary angiography and phlebography, and recurrences can be prevented by anticoagulation and partial interruption of the inferior vena cava, when the emboli arise from its territory.

[Acut aortic insufficiency caused by rupture of a normal valve during labor]. / Insuficiencia aórtica aguda por rotura de una valvula normal durante el parto

We are presenting a case of a young woman with sudden onset of heart failure and several episodes of syncope, after a prolonged labor. The findings at physical examination suggested the diagnosis of acute aortic insufficiency, that was confirmed by cardiac catheterization. At surgery, the aortic valve showed a round perforation in the non coronary cusp. Pathological examination of the valve showed no significant abnormality. We conclude that the stress of labor was the cause of the rupture of a previously normal aortic valve.